Cancer remains the single biggest reason for years of life lost in the UK, accounting for over one in three of all years of life lost, more than the next three causes of death added together. Earlier diagnosis of cancer improves survival, reduces treatment burden, and provides the best opportunity for positive outcomes from a cancer diagnosis.

Across Wessex we will continue and step up our multi-agency ‘every effort’ collaboration to detect 75% cancers at stage 1 or 2 by 2028

To do this we will:

1. Improve the number of cancers diagnosed at Stage 1 and 2 for people in Wessex; prioritising the tumour types where earlier stage diagnosis has the greatest impact on survival.
2. Improve pathway effectiveness and efficiency to make earlier diagnosis as simple as possible.
3. Increase awareness of cancer signs and symptoms among our population.
4. Improve awareness and uptake of screening and diagnostic tests for cancer.

Aim: Improve the number of cancers diagnosed at Stage 1 and 2 for people in Wessex; prioritising the tumour types where earlier stage diagnosis has the greatest impact on survival.

Survival for both bowel and lung cancer are worse in the UK compared to countries with similar health systems ​^{(Araghi, 2022)}​. In Wessex, the current average proportion of diagnosis at stages 1 and 2 is 51.7% in bowel cancer and 35.9% in lung cancer. For both bowel and lung cancers, proven interventions exist to diagnose cancer earlier.

Objective: We will collectively commit to focus on improving the stage of diagnosis of tumour site areas, starting with, but not limited to, bowel and lung cancer, for all people in Wessex.

• We will work in partnership with our population to ensure usable diagnostic services are open to people where they can access them equitably, to allow people to seek help in response to early signs or symptoms of cancer.
• We will build on existing Community Diagnostic Centre models to develop cancer diagnosis pathways closer to home, rather than limited to where the clinical services currently exist.
• Aligned with our research and innovation principles and actions, we will work with local teams and organisations such as Health Innovation Wessex, to identify and pilot proven innovations and new ways of working that will support the earlier detection of cancers.

Lung Cancer

Smoking is still the largest preventable cause of illness, death, and health inequalities in England. It is associated with almost every indicator of deprivation. Those already experiencing high levels of deprivation and health inequalities are more likely to smoke, such as manual workers and those with long term mental health conditions.

In line with the Dorset Joint Forward Plan, we will aim to reduce the gap in healthy life expectancy.

In Portsmouth, the proportion of adults who continue to smoke across the population is 10.1%​ ^{(PHE, 2023)}​ but is 17.4% for routine and manual workers. Smoking rates amongst routine and manual workforce in Dorset ICB are the highest of any ICB in England. ​^{(PHE, 2024)}​

Objective: We will roll out the Lung Cancer Screening Programme (formally Targeted Lung Health Checks) for all Wessex by 2028 by:

• Working in partnership with communities and Integrated Neighbourhood Teams to support codesigned, tailored and targeted public engagement to encourage informed participation and minimise reinforcing stigma around certain communities.
• Ensuring smoking cessation interventions are funded and integrated into the Lung Cancer Screening Programme.
• Ensuring commissioning planning aligns to provide adequate diagnostic and treatment capacity to allow for increased volume of earlier lung cancers detected.
• Increasing the uptake of the Lung Cancer Screening Programme to at least 70% by 2030, prioritising our most deprived communities first.
• Collaborating with clinical leaders across primary and secondary care to identify opportunities and need for piloting innovative approaches that will support the delivery of the Lung Cancer Screening Programme, delivering the full service as quickly and cost effectively as we are able.

Smoking is not the only cause of lung cancer. Up to 14% of cases are not related to smoking. We will increase awareness and access to diagnostic tests for all our population, being mindful of air quality and some increased occupational risks.

Bowel Cancer

Nationally, there is a positive correlation between deprivation and bowel cancer mortality, where the diagnosis rate is 28% higher for males living in the 20% most deprived areas of England.

In Southampton the mortality from colorectal cancer has been increasing from 2014-16 and is now significantly higher than for the rest of England. The three highest rates within Wessex are observed in Southampton, Gosport and Isle of Wight.

The Faecal Immunochemical Test (FIT) threshold for symptomatic testing is 10 µg Hb/g faeces. For screening it is currently 120 µg Hb/g faeces. This simple investigation detects blood in faeces and is an important indicator of possible bowel cancer.

• We will work with public health teams, pharmacy, optometry, and the voluntary and community sector to raise awareness of the signs and symptoms of bowel cancer and encourage people to seek medical advice early.
• We will work in partnership with the Primary Care Networks and the voluntary and community sector to increase access and awareness of the bowel cancer screening programme, focusing particularly on those who are currently less likely to participate.
• We will support Public Health Commissioning to lower the screening threshold from 120 to 80 µg Hb/g faeces for adults aged 50-74 years.
• We will enable transformation of bowel symptomatic pathways to create the capacity for the additional screening workload.
• We will work in partnership with communities and primary care to improve equity of awareness, access and uptake of FIT testing where people have symptoms.
• We will collaborate with clinical leaders across primary and secondary care to identify and pilot innovative approaches that will increase the early diagnosis of bowel cancer, while ensuring sufficient capacity for timely testing and results, follow-on diagnostic pathways and treatment as required.
• We will work with people with learning disabilities and their carers to address the known disparity in bowel cancer deaths (15.8% of cancer deaths, compared to 10% for the general population.)

Aim: Improve pathway effectiveness and efficiency to make earlier diagnosis as simple as possible.

 In order to achieve this we will:

• Work with primary care and secondary care leaders, including dentistry and pharmacy, to identify and pilot innovative and proven approaches that will streamline referral pathways, to make it as easy as possible to access diagnostic tests when needed.
• Address and reduce referral variations in primary care.
• Work proactively with secondary care and support clinical teams to ensure swift transition from test result to management plan.
• Work with Clinical Advisory Groups (Site Specific Groups in Dorset) to understand and address variation in stage of diagnosis where data suggests variation exists based on geography alone.
• Develop and enable self-referral pathways, building on learning from the non-specific symptoms pathway, by digital and clinical triage, for people with concerning symptoms where workforce and health economics allow based on the principles of providing care as close to home as possible.
• Work with local primary care and secondary care leaders and organisations such as Health Innovation Wessex, to identify suitable digital technologies, such as decision support tools for primary care, symptom identifiers and risk calculators for patients and cancer helplines, to enable earlier awareness and detection of cancer.

Aim: Increase awareness of cancer signs and symptoms amongst our population, targeting communities with latest stage of diagnosis.

 The 2023 Cancer Awareness Measure reported that just 49% of people in England who experienced a cancer symptom contacted their doctor about it within six months of noticing it and the National Cancer Patient Experience Survey (NCPES) shows that this is significantly lower in areas of deprivation across Wessex.

In order to achieve this, we will:

• Support timely presentation, continue to build on partnerships and community led awareness campaigns evidenced to improve understanding amongst community groups.
• Support primary care to utilise data and knowledge of their population to act on risk stratified case finding (proactive, symptomatic diagnosis) for certain communities and certain tumour types, with a focus on lung and bowel cancer, but recognising this will later extend to other tumour types over the period of this plan.

Communication is key to reaching all people and communities and the way in which we receive information has changed for many. Working with stakeholders we will seek to use communication technology more effectively to raise public awareness of cancer symptoms and improve access to healthcare information and services.

Aim: Improve awareness and uptake of screening and diagnostic tests for cancer, prioritising areas of lowest uptake and latest stage of diagnosis.

In order to achieve this we will:

• Continue to support earlier diagnosis surveillance pathways for high-risk patients, including those identified from their genomic profile or family history.
• Provide training across primary care to ensure knowledge is up to date.
• Improve access to cervical screening through increased awareness and self-sampling when available.
• Work with Public Health Commissioning Teams to improve the uptake and coverage of cancer screening programmes particularly among those who experience health inequalities, in line with the Core20Plus5 agenda. (The national approach to support reduction of health inequalities across a system, focused on the 20% most deprived plus specific communities experiencing inequality.)
• Identify opportunities to offer one-stop combined screening to improve uptake and experience, for example bowel FIT kits at lung, breast, and cervical screening appointments where eligible.
• Work with planning teams to ensure the necessary capacity at every stage, to make sure that people have a smooth journey through the whole screening pathway.
• Be proactive, as cancer is detected earlier and patients are surviving longer, in monitoring disease recurrence and progression. To do this we will align digital solutions, including wearable technology, to ensure timely monitoring and work to ensure sufficient diagnostic capacity across our systems.
• Be proactive about emerging less/non-invasive markers such as circulating tumour DNA (ctDNA) and advanced imaging, where the evidence supports adoption.